Question 1

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery.According to QI,to correct the problem the educator,in consultation with the patient care manager,would initially do which of the following?
A) Talk to the staff individually to determine why this is occurring.
B) Call a meeting of all staff to discuss this issue.
C) Have a group of staff nurses review the established standards of care for postoperative patients.
D) Document which staff members are not recording vital signs,and write them up.

Accepted Answer

Calling a meeting of all staff to discuss the issue is a good initial step as it allows for open communication and collaboration in identifying the root cause of the problem and potential solutions. Talking to staff individually may not reveal the full extent of the problem, and documenting which staff members are not recording vital signs and writing them up may create a negative and punitive atmosphere rather than focusing on identifying and addressing the problem. Reviewing the established standards of care may be helpful but may not address the root cause of the issue.

Question 2

A nurse manager wants to decrease the number of medication errors that occur in her department.The manager arranges a meeting with the staff to discuss the issue.The manager conveys a philosophy of total quality management (QM)by:
A) Explaining to the staff that disciplinary action will be taken in cases of additional errors.
B) Recommending that a multidisciplinary team assess the root cause of errors in medication.
C) Suggesting that the pharmacy department explore its role in the problem.
D) Changing the unit policy to allow a certain number of medication errors per year without penalty.

Accepted Answer

Total quality management (TQM) is a systematic approach to quality improvement that involves all staff members in the organization. It aims to identify and eliminate the root cause of problems rather than punishing individuals for errors. By recommending a multidisciplinary team to assess the root cause of medication errors, the nurse manager is applying TQM principles, which focus on continuous improvement and teamwork. Option A is punitive and may create a culture of fear and blame, which is counterproductive to TQM. Option C suggests blaming the pharmacy department without getting input from them and does not involve working collaboratively. Option D does not address the problem but instead accepts a certain number of errors, which is not aligned with TQM principles.

Question 3

A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?
A) Histogram.
B) Flowchart.
C) Fishbone diagram.
D) Pareto chart.

Accepted Answer

A histogram is the most appropriate organizational tool for visualizing the frequency of errors occurring with different patients. It allows for the display of numerical data in a graphical form, making it easy to identify patterns and trends in the frequency of errors. This can be useful for identifying areas where process improvements may be needed, and for tracking the effectiveness of any interventions implemented.

Question 4

A new graduate is asked to serve on the hospital's quality improvement (QI)committee.The nurse understands that the first step in quality improvement is to:
A) Collect data to determine whether standards are being met.
B) Implement a plan to correct the problem.
C) Identify the standard.
D) Determine whether the findings warrant correction.

Accepted Answer

The first step in quality improvement is to identify the standard. This involves defining what good quality care looks like, and setting specific criteria and measures to evaluate whether those standards are being met. Without a clear standard, it is impossible to collect accurate data, implement an effective plan, or determine whether findings warrant correction.

Question 5

Hospital ABCD is a Magnet hospital.This designation has been applied to Hospital ABCD because it:
A) Facilitates active staff participation in decision-making related to quality nursing care.
B) Has implemented a graduate nurse orientation program.
C) Espouses commitment to excellence in patient care.
D) Is establishing career ladders for nurses.

Accepted Answer

Magnet hospitals are particularly successful in implementing excellence in patient care through use of standards,evidence,and participatory decision making in quality improvement.Organizations that cannot pursue Magnet™ status can implement strategies such as career ladders.

Question 6

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit.The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?
A) "It promotes teamwork among health care providers."
B) "It increases adverse events."
C) "It improves outcomes."
D) "It contributes to duplication of services."

Accepted Answer

Nursing research has validated that a low nurse-to-patient ratio improves outcomes.

Question 7

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process,a QI team might turn to which of the following for confirmatory evidence?
A) Best Practice Guidelines (BPGs).
B) North American Nursing Diagnosis Association (NANDA).
C) National Quality Institute.
D) Agency for Healthcare Research and Quality.

Accepted Answer

Best Practice Guidelines (BPGs) provide evidence-based recommendations for the prevention and management of various health conditions, including falls. They are developed by experts in the field based on a thorough review of the current literature and are widely recognized as reliable sources of information. Therefore, they would be a suitable source of confirmatory evidence for the QI team to use in identifying effective preventive measures for injury-producing falls. The other options listed do not specifically relate to falls or injury prevention.

Question 8

A nurse is explaining the pediatric unit's QI program to a newly employed nurse.Which of the following would the senior nurse include as the primary purpose of QI programs?
A) Evaluation of staff members' performances.
B) Determination of the appropriateness of standards.
C) Improvement in patient outcomes.
D) Preparation for accreditation of the organization by The Joint Commission.

Accepted Answer

The primary purpose of QI programs is to improve patient outcomes, which involves identifying areas of improvement, implementing changes, and monitoring the effects of those changes on patient care. While evaluations of staff performance and determination of appropriateness of standards are important components of QI, they are secondary to the primary goal of improving patient outcomes. Accreditation by The Joint Commission is also an important aspect of healthcare organizations, but it is not the primary purpose of QI programs.

Question 9

At Hospital Ajax,staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame.This culture demonstrates:
A) QM principles that emphasize customer safety.
B) a deep concern with improvement of quality and processes.
C) effective employee orientation and development in relation to QM.
D) goals that are inconsistent with QM.

Accepted Answer

The culture at Hospital Ajax is inconsistent with QM principles because it does not prioritize a blame-free environment that encourages open reporting and learning from errors to improve processes and prevent future occurrences. Instead, it fosters a culture of fear and reluctance to admit mistakes, which is counterproductive to achieving QM goals.

Question 10

The outcome statement "Patients will experience a 10% reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is:
A) Physician sensitive and nonmeasurable.
B) Measurable and nursing sensitive.
C) Precise,measurable,and physician sensitive.
D) Patient care centred and nonmeasurable.

Accepted Answer

The outcome statement is measurable (10% reduction in urinary tract infections) and nursing-sensitive (related to staff training and prompted voiding). It is not physician-sensitive as it is related to nursing interventions.

Question 11

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin.A root-cause analysis is very similar to the QI process except that a root-cause analysis is:
A) Retrospective.
B) Prospective.
C) Legislated for completion with all near-miss events.
D) Conducted by only one person.

Accepted Answer

A root-cause analysis is a retrospective process that aims to identify the underlying causes of an adverse event or error. It involves a systematic and thorough investigation of a specific incident, with the goal of identifying the underlying causes and developing recommendations to prevent similar incidents from occurring in the future.

Question 12

Before beginning a continuous QI project,a nurse should determine the minimal safety level of care by referring to which of the following?
A) The procedure manual.
B) Nursing care standards.
C) The litigation rate of unsafe practice.
D) Job descriptions of the organization.

Accepted Answer

Nursing care standards are designed to ensure a minimal level of safety and quality care. They provide specific guidelines for nursing practice and help to ensure that all patients receive consistent and appropriate care. The other options may provide some information, but they are not as directly relevant to determining the minimal safety level of care.

Question 13

An example of an effective patient outcome statement is:
A) "Eighty percent of all patients admitted to the emergency department will be seen by a nurse practitioner within 3 hours of presentation in the emergency department."
B) "Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs."
C) "The hospital will reduce costs by 3% through the annual budget process."
D) "Quality is a desired element in patient transactions."

Accepted Answer

Option A is the only statement that is specific, measurable, achievable, relevant, and time-bound (SMART). It clearly defines the outcome, the target population, the timeline, and is measurable. This statement also focuses on improving the patient experience and outcomes by ensuring timely care by the appropriate healthcare provider. Option B focuses on referral to rehabilitation programs for one specific diagnosis, which may not be relevant for all patients. Option C is focused on reducing hospital costs, which may not necessarily result in improved patient outcomes. Option D is too vague and does not provide any specific measurable outcome.

Question 14

Your institution has identified a recent rise in postsurgical infection rates.As part of your QI analysis,you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics.Such a determination is known as:
A) Quality assurance.
B) Sentinel data.
C) Benchmarking.
D) Statistical analysis.

Accepted Answer

Benchmarking involves comparing one's performance or outcomes with those of similar organizations, with the goal of identifying areas for improvement. This is exactly what is being sought in this scenario, as the institution is interested in comparing its infection rates with those of other institutions with similar characteristics. Quality assurance involves monitoring and evaluating processes to ensure quality outcomes, whereas sentinel data are specific types of data used for surveillance of particular health events or trends. Statistical analysis could be used as a tool in benchmarking, but it is not the overarching approach.

Question 15

Patient perceptions are useful in:
A) Determining disciplinary actions in QI.
B) Establishing the competitive advantage of QI decisions.
C) Establishing priorities among possible changes to care identified in QI.
D) Establishing blame for poor-quality care.

Accepted Answer

Patient perceptions are useful in identifying areas for improvement in quality of care. By understanding what patients perceive as important and valuable in their care, healthcare organizations can prioritize and make changes to improve patient satisfaction and experience. Patient perceptions should not be used to determine disciplinary actions or blame, as quality of care is a collective responsibility of the healthcare team. Additionally, patient perceptions may not always align with a healthcare organization's competitive advantage or strategy in QI.

Question 16

Which of the following is not a principle of high reliability organizations?
A) Sensitivity to operations.
B) Preoccupation with failure.
C) Commitment to resiliency.
D) Reluctance to simplify.
E) Indeference to expertise.

Accepted Answer

High reliability organizations place great emphasis on expertise and prioritize obtaining the most skilled individuals in their fields. Therefore, indifference to expertise is not a principle of high reliability organizations.

Question 17

The nurse gives an inaccurate dose of medication to a patient.After assessment of the patient,the nurse completes an incident report.The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence.The nurse who administered the inaccurate medication understands that:
A) The error will result in suspension.
B) An incident report is optional for an event that does not result in injury.
C) The error will be documented in her personnel file.
D) Risk management programs are not designed to assign blame.

Accepted Answer

Risk management programs, including the use of incident reports, are designed to identify and mitigate risks, not to assign blame. They aim to improve systems and processes to prevent future errors.

Question 18

With the rise of workplace violence in the emergency department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should:
A) Request all staff to accept new risk management practices.
B) Hold staff accountable for safe practices.
C) Document inappropriate behaviour.
D) Hire more police security.

Accepted Answer

Holding staff accountable for safe practices is a proactive approach to violence prevention, ensuring that everyone adheres to established protocols and contributes to a safer work environment.

Question 19

As a nurse manager,you know that the satisfaction of patients is critical in making QI decisions.You propose to circulate a questionnaire to discharged patients,asking about their experiences on your unit.Your supervisor cautions you to also consider other sources of data for decisions because:
A) The return rate on patient questionnaires is frequently low.
B) Patients are rarely reliable sources about their own hospital experiences.
C) Hospital experiences are frequently obscured by pain,analgesics,and other factors affecting awareness.
D) Patients are reliable sources about their own experiences,but are limited in their ability to gauge clinical competence of staff.

Accepted Answer

Patients are reliable and motivated sources of their own experience but often do not have sufficient knowledge of clinical procedures to provide feedback about clinical competence.

Question 20

The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveys.The first step in addressing this issue from the point of view of quality improvement is which of the following?
A) Assemble a team.
B) Establish a benchmark.
C) Identify a clinical activity for review.
D) Establish outcomes.

Accepted Answer

The first step in quality improvement is to identify a specific clinical activity or process that needs review and improvement.

Quiz 22: Understanding Quality, risk, and Safety

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery.According to QI,to correct the problem the educator,in consultation with the patient care manager,would initially do which of the following?

A nurse manager wants to decrease the number of medication errors that occur in her department.The manager arranges a meeting with the staff to discuss the issue.The manager conveys a philosophy of total quality management (QM) by:

A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?

A new graduate is asked to serve on the hospital's quality improvement (QI) committee.The nurse understands that the first step in quality improvement is to:

Hospital ABCD is a Magnet hospital.This designation has been applied to Hospital ABCD because it:

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit.The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process,a QI team might turn to which of the following for confirmatory evidence?

A nurse is explaining the pediatric unit's QI program to a newly employed nurse.Which of the following would the senior nurse include as the primary purpose of QI programs?

At Hospital Ajax,staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame.This culture demonstrates:

The outcome statement "Patients will experience a 10% reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is:

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin.A root-cause analysis is very similar to the QI process except that a root-cause analysis is:

Before beginning a continuous QI project,a nurse should determine the minimal safety level of care by referring to which of the following?

An example of an effective patient outcome statement is:

Your institution has identified a recent rise in postsurgical infection rates.As part of your QI analysis,you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics.Such a determination is known as:

Patient perceptions are useful in:

Which of the following is not a principle of high reliability organizations?

With the rise of workplace violence in the emergency department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should:

As a nurse manager,you know that the satisfaction of patients is critical in making QI decisions.You propose to circulate a questionnaire to discharged patients,asking about their experiences on your unit.Your supervisor cautions you to also consider other sources of data for decisions because:

The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveys.The first step in addressing this issue from the point of view of quality improvement is which of the following?